What is the recommended cream for itching?

Recommended Creams for Itching

For most cases of generalized itching without an underlying skin condition, emollients and 1% hydrocortisone cream are the first-line topical treatments. 1, 2

First-Line Topical Treatments

• Emollients (moisturizers) should be applied at least once daily to the whole body as the foundation of itch management, particularly for dry skin 2
• Hydrocortisone 1% cream can be applied to affected areas up to 3-4 times daily for temporary relief of itching associated with minor skin irritations, inflammation, and rashes 1
• For adults and children over 2 years of age, hydrocortisone cream can be applied directly to the affected area, while children under 2 require physician guidance 1

Treatment Based on Underlying Cause

For Generalized Pruritus of Unknown Origin (GPUO):

• Start with self-care advice and emollients as first-line treatment 2
• Topical options to consider include:
  • Menthol-containing preparations for their cooling effect 2
  • Topical doxepin (limited to 8 days, 10% of body surface area, and 12g daily) 2
  • Avoid crotamiton cream, topical capsaicin, and calamine lotion as they are not recommended 2

For Specific Conditions:

• Uremic pruritus: Consider capsaicin cream or topical calcipotriol 2
• Hepatic pruritus: Topical tacrolimus ointment may be considered as a fifth-line treatment 2
• Eczematous conditions: Short-term topical steroids such as prednicarbate cream 0.02% 2
• Xerotic (dry) skin with pruritus:
  • Oil-in-water creams or ointments are preferred over alcohol-containing lotions 2
  • Urea- or polidocanol-containing lotions can help soothe pruritus 2
  • Moisturizers with high lipid content may be preferred in elderly patients 2

Specialized Formulations

• Ceramide-containing formulations with 1% pramoxine hydrochloride have shown rapid and long-lasting relief of itching in patients with atopic history, comparable to hydrocortisone 1% cream 3
• Phosphodiesterase-4 (PDE-4) inhibitors like crisaborole may be considered for mild to moderate atopic dermatitis as an alternative to topical corticosteroids 2

Important Considerations and Cautions

• Topical antihistamines are generally not recommended as they may increase the risk of contact dermatitis 2, 4
• Long-term use of topical antibiotics should be avoided due to increased risk of resistance and sensitization 2
• For itching associated with EGFR inhibitor therapy, skin moisturizers and urea- or polidocanol-containing lotions are suitable 2
• Sedative antihistamines should be avoided long-term except in palliative care settings, as they may predispose to dementia 2

Application Techniques

• For external anal and genital itching, clean the affected area with mild soap and warm water, rinse thoroughly, and gently pat dry before applying medication 1
• When bathing, avoid hot showers and excessive use of soaps that can dehydrate the skin 2
• Apply emollients immediately after bathing to lock in moisture 2

Remember that identifying and treating any underlying cause of itching is essential for long-term relief. If symptoms persist despite appropriate topical therapy, referral to a specialist may be necessary 2.